MEDICARE: HEALTHY HAVEN HEALTHCARE

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207Q00000X	Family Medicine Physician

General Provider Information

NPI Number	:	1891478996
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	HEALTHY HAVEN HEALTHCARE

Provider Business Mailing Address
First Line	:	201 SOUTHVIEW DR
Second Line	:
City	:	HUDSON OAKS
State	:	TX
Zip	:	76087-8232
Country	:	US
Telephone Number	:	863-528-5627
Fax Number	:

Provider Business Practice Location Address
First Line	:	1508 SANTA FE DR STE 103
Second Line	:
City	:	WEATHERFORD
State	:	TX
Zip	:	76086-5859
Country	:	US
Telephone Number	:	817-242-5789
Fax Number	:	888-752-9156

Authorized Official
Title or Position	:	OWNER/FNP-C
Name	:	KIMBERLY NICHOLE SCOTT
Credential	:	FNP-C
Telephone Number	:	863-528-5627

Provider Enumeration Date	:	08/08/2023
Last Update Date	:	03/13/2026

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